1
|
Galvez-Olortegui J, Burgueño-Montañes C, Silva-Ocas I, Bernales-Urbina S, Galvez-Olortegui T. Minimally Invasive Glaucoma Surgery (MIGS) recommendations in Clinical Practice Guidelines for open angle glaucoma and MIGS procedures: A scoping review. Eur J Ophthalmol 2024:11206721241276223. [PMID: 39175231 DOI: 10.1177/11206721241276223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Introduction: To assess the recommendations of open angle glaucoma Clinical Practice Guidelines (CPG) addressing Minimally Invasive Glaucoma Surgery (MIGS) or MIGS procedures CPG. Methods: A scoping review of CPG was conducted, based on an ongoing systematic review (CRD42024510656). A systematic literature search of CPG was carried out in November 2023, with an update in January 2024. CPG published in the last 8 years, full text available and addressing MIGS were selected. CPG details and recommendations concerning MIGS were extracted. Results: 13 CPG addressing MIGS were selected (8 recovered from databases and 5 from registers). Four health Technology Assessments were assessed but recommendations were not considered. Finnish and Swedish guidelines, published in 2024, and Japanese guidelines, published in 2023, are English versions of their native language guidelines, but none of them make specific recommendations about MIGS. The Spanish Glaucoma Society - Advanced Glaucoma guideline (2023) describes the available techniques but does not make recommendations about MIGS. The European Glaucoma Society (2023) guideline only makes recommendations for 4 devices and the National Institute for Health and Care Excellence Interventional procedures guidance makes recommendations both for specific procedures and devices. Conclusion: MIGS is a relevant topic that has not been adequately addressed in terms of updated evidence, available procedures, and recommendations in open angle glaucoma CPG or MIGS procedures CPG.
Collapse
Affiliation(s)
- Jose Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad Nacional de Tumbes, Tumbes, Perú
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Perú
| | - Carmen Burgueño-Montañes
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
- Service of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Isabel Silva-Ocas
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Perú
| | - Susan Bernales-Urbina
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Perú
| | - Tomas Galvez-Olortegui
- Evidence Based Ophthalmology Unit (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
- Centro de Excelencia en Glaucoma, Clinica GO-Vision, Lima, Perú
- Department of Ophthalmology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| |
Collapse
|
2
|
Yadav A, Meena J, Kumar J. Network metanalysis on probiotics in functional constipation in children. Eur J Pediatr 2024:10.1007/s00431-024-05722-0. [PMID: 39138676 DOI: 10.1007/s00431-024-05722-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
In this correspondence, we raised our concerns about the methodological issues in the recent network meta-analysis by Yang et al. These issues require close attention because such meta-analysis forms the basis of major guidelines and helps clinicians make informed decisions.
Collapse
Affiliation(s)
| | - Jitendra Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jogender Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| |
Collapse
|
3
|
Deng YP, Zhou YL, Wei TT, He GS, Zhu ZX, Zhang SN, Liu MJ, Xue JJ, Zhang WX, Yang XG. Combined traditional Chinese medicine therapy for the treatment of infertility with polycystic ovary syndrome: A network meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e38912. [PMID: 38996123 PMCID: PMC11245265 DOI: 10.1097/md.0000000000038912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) infertility has attracted great attention from researchers due to its high incidence. Numerous studies have shown that Chinese medicine is effective in treating this disease, but there is a wide variety of Chinese medicine therapies available, and there is a lack of comparative evaluation of the efficacy of various Chinese medicine combination therapies in the clinic, which requires further in-depth exploration. This study aims to evaluate the efficacy of a combined traditional Chinese medicine (TCM) therapy for the treatment of infertility with PCOS using network meta-analysis (NMA). METHODS In PubMed, web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Data, VIP Database, China Biomedical Literature Database (SinoMed) databases, searchs were conducted for information about the randomized controlled trials (RCTs) of combined TCM therapy for the treatment of infertility with PCOS. Quality evaluation was performed using the Cochrane 5.3 risk of bias assessment tool, and NMA using Stata 16.0. RESULTS This study comprised 28 RCTs using 8 combined TCM therapies in total. The results of the NMA showed that moxibustion + herbal, fire acupuncture + herbal, acupuncture + herbal, electroacupuncture + herbal, and acupoint application + herbal improved the clinical pregnancy rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Additionally, ear point pressure + herbal enema + herbal, acupuncture and moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal improved the ovulation rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal are the 3 most effective therapies for improving the clinical pregnancy rate. Fire acupuncture + herbal, acupuncture + herbal, and ear point pressure + herbal enema + herbal are the 3 most effective therapies for improving the ovulation rate. CONCLUSION The combined TCM therapy demonstrated better efficacy for the treatment of infertility with PCOS compared to acupuncture, herbal, and western medicines monotherapy. However, the optimal treatment therapy varied depending on the outcome indicators. Further large sample, high-quality, and standardized RCTs are needed to verify these findings.
Collapse
Affiliation(s)
- Yun-Peng Deng
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yan-Li Zhou
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Teng-Teng Wei
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Guang-Shuai He
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhi-Xin Zhu
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shu-Ning Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Mei-Jun Liu
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jing-Jing Xue
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Wei-Xing Zhang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xu-Guang Yang
- Henan University of Chinese Medicine, Zhengzhou, China
- Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| |
Collapse
|
4
|
Kashir I, Madden K. Cochrane in CORR® : Pharmacological Interventions for the Prevention of Bleeding in People Undergoing Elective Hip or Knee Surgery: A Systematic Review and Network Meta-analysis. Clin Orthop Relat Res 2024; 482:1120-1126. [PMID: 38913545 PMCID: PMC11219145 DOI: 10.1097/corr.0000000000003133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Imad Kashir
- Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Research Institute of St. Joseph's Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Ishaq I, Skinner IW, Mehta P, Walton DM, Bier J, Verhagen AP. Clinical validation of grouping conservative treatments in neck pain for use in a network meta-analysis: a Delphi consensus study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:166-175. [PMID: 37943373 DOI: 10.1007/s00586-023-08025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND A network meta-analysis aims to help clinicians make clinical decisions on the most effective treatment for a certain condition. Neck pain is multifactorial, with various classification systems and treatment options. Classifying patients and grouping interventions in clinically relevant treatment nodes for a NMA is essential, but this process is poorly defined. OBJECTIVE Our aim is to obtain consensus among experts on neck pain classifications and the grouping of interventions into nodes for a future network meta-analysis. DESIGN A Delphi consensus study involving neck pain experts worldwide. METHODS We invited authors of neck pain clinical practice guidelines published from 2014 onwards. The Delphi baseline questionnaire was developed based on the findings of a scoping review, including four items on classifications and 19 nodes. Participants were asked to record their level of agreement on a seven-point Likert scale or using Yes/No/Not sure answer options for the various statements. We used descriptive analysis to summarise the responses on each statement with content analysis of the free-text comments. RESULTS In total, 18/80 experts (22.5%) agreed to participate in one or more Delphi rounds. We needed three rounds to reach consensus for two classification of neck pain: one based on aetiology and one on duration. In addition, we also reached consensus on the grouping of interventions, including a definition of each node, with the number of nodes reduced to 17. CONCLUSION With this consensus we clinically validated two neck pain classifications and grouped conservative treatments into 17 well-defined and clinically relevant nodes.
Collapse
Affiliation(s)
- Iqra Ishaq
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia
| | - Ian W Skinner
- School of Allied Health Exercise and Sports Sciences, Charles Sturt University, Port Macquarie, NSW, Australia
| | - Poonam Mehta
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Jasper Bier
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
- FS Fysio, Capelle aan den IJssel, The Netherlands
| | - Arianne P Verhagen
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, 100 Broadway, Ultimo, 2007, Australia.
| |
Collapse
|
6
|
Xu T, Deng B, Lin S, Wang H, Xu Y, Chen G. Comparative efficacy of acupuncture-related therapy for postmenopausal osteoporosis: protocol for Bayesian network meta-analysis. BMJ Open 2023; 13:e074740. [PMID: 38159952 PMCID: PMC10759059 DOI: 10.1136/bmjopen-2023-074740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION The review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal osteoporosis, ranking the best acupuncture treatment and providing a reference for clinical treatment extensively. METHODS AND ANALYSIS Randomised controlled trials of different acupuncture-related therapies for postmenopausal osteoporosis will be searched in the following databases from 1 January 2002 to 31 December 2022, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biomedical Literature Database. Overall, clinical efficacy rate, bone mineral density and a Visual Analogue Scale score are used as the primary outcome indicators. In addition, the secondary outcome indicator is adverse reactions. The entire screening process will be conducted by two independent investigators; meanwhile, Stata (V.14.0) and RevMan (V.5.4) will be used to conduct the network meta-analysis. If the data are permissible and feasible, we will also perform meta-regression and subgroup analyses to address the underlying causes of data inconsistency and heterogeneity in the statistical analyses. Besides, to improve the credibility of this network meta-analysis, we will evaluate the quality of evidence in this research according to the GRADE assessment. ETHICS AND DISSEMINATION Ethics approval is not required for network meta-analyses, which do not involve animals' or people's welfare. The results of this network meta-analysis will be submitted to a recognised journal for publication. PROSPERO REGISTRATION NUMBER CRD42023401003.
Collapse
Affiliation(s)
- Tiantian Xu
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Bing Deng
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shen Lin
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongjin Wang
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yunxiang Xu
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guizhen Chen
- The Seventh Clinical Medicial College of Guangzhou University of Chinese Medicine, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| |
Collapse
|
7
|
Ceriello A, Rodbard HW, Battelino T, Brosius F, Cosentino F, Green J, Ji L, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Parkin CG, Rydén L, Sheu WHH, Standl E, Vandvik PO, Schnell O. Data from network meta-analyses can inform clinical practice guidelines and decision-making in diabetes management: perspectives of the taskforce of the guideline workshop. Cardiovasc Diabetol 2023; 22:277. [PMID: 37833776 PMCID: PMC10576408 DOI: 10.1186/s12933-023-01993-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
In recent years, several novel agents have become available to treat individuals with type 2 diabetes (T2D), such as sodium-glucose cotransporter-2 inhibitors (SGLT-2i), tirzepatide, which is a dual glucose-dependent insulinotropic polypeptide receptor agonist (GIP RA)/glucagon-like peptide-1 receptor agonist (GLP-1 RA), and finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA) that confers significant renal and cardiovascular benefits in individuals with (CKD). New medications have the potential to improve the lives of individuals with diabetes. However, clinicians are challenged to understand the benefits and potential risks associated with these new and emerging treatment options. In this article, we discuss how use of network meta-analyses (NMA) can fill this need.
Collapse
Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, 20099, Sesto San Giovanni, MI, Italy
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD, 20852, USA
| | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724-5022, USA
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, DUMC Box 3850, Durham, NC, 27715, USA
| | - Linong Ji
- Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing, China
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Germany
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI, 53703, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO, 64111, USA
- The George Institute for Global Health and University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- University Clinical Center of Serbia, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Christopher G Parkin
- CGParkin Communications, Inc., 2675 Windmill Pkwy, Suite 2721, Henderson, NV, 89074, USA
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | - Wayne Huey-Herng Sheu
- Institute of Molecular and Genomic Medicine, National Research Health Institutes, Zhunan, Miaoli, 350, Taiwan
| | - Eberhard Standl
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Oliver Schnell
- Forschergruppe Diabetes E. V, Ingolstaedter Landstraße 1, Neuherberg, 85764, Munich, Germany.
| |
Collapse
|
8
|
Liyew AM, Gilmour B, Clements AC, Alene KA. Comparative effectiveness of interventions for preventing tuberculosis: systematic review and network meta-analysis of interventional studies. EClinicalMedicine 2023; 64:102209. [PMID: 37731939 PMCID: PMC10507197 DOI: 10.1016/j.eclinm.2023.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
Background Tuberculosis (TB) is the leading infectious cause of death globally. Several preventive measures are employed to prevent TB, yet there is a paucity of evidence on the effectiveness of these interventions. Therefore, this study aimed to identify the most effective interventions for reducing TB incidence. Methods A systematic search was undertaken across five relevant databases including PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to February 22, 2023. Bayesian network meta-analysis (NMA) was conducted to compare the effectiveness of preventive interventions including preventive therapy, nutritional intervention, targeted screening, and vaccination in reducing TB incidence. Subgroup analysis was conducted to investigate the effectiveness of TB preventive treatments. Findings Overall 82 articles were included in the NMA. Preventive therapy (OR = 0.44, 95% CrI 0.36-0.52), BCG vaccination (OR = 0.62, 95% CrI 0.39-0.98) and TB candidate vaccines (OR = 0.67, 95% CrI 0.46-0.98) were more effective than placebo or no intervention. When all active interventions were considered, preventive therapy ranked as the best intervention. Of the preventive treatments, isoniazid (OR = 0.46, 95% CrI 0.35-0.55), isoniazid plus rifampicin (OR = 0.56, 95% CrI 0.32-0.97), isoniazid plus rifapentine (OR = 0.49, 95% CrI 0.29-0.83), isoniazid plus ethambutol (OR = 0.39, 95% CrI 0.15-0.99), isoniazid plus streptomycin (OR = 0.12, 95% CrI 0.02-0.55), rifampicin (OR = 0.41, 95% CrI 0.18-0.92), and rifampicin plus pyrazinamide (OR = 0.51, 95% CrI 0.29-0.87) surpassed placebo/none. Interpretation Our study suggested that when all available preventive interventions are considered, preventive therapy is likely the most effective intervention. Within TB preventive treatments, isoniazid plus streptomycin is likely ranked at the top. This comparative study provides important information for policymakers and stakeholders, enabling them to make informed decisions on preventive strategies, whilst considering local resources and capacity constraints. Funding Curtin University strategic scholarship and Australian National Health and Medical Research Council, through an Emerging Leadership Investigator grant.
Collapse
Affiliation(s)
- Alemneh Mekuriaw Liyew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
| | - Beth Gilmour
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
| | - Archie C.A. Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - Kefyalew Addis Alene
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
| |
Collapse
|
9
|
Asimakidou E, Sidiropoulos C. A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity. Toxins (Basel) 2023; 15:toxins15040256. [PMID: 37104194 PMCID: PMC10145352 DOI: 10.3390/toxins15040256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.
Collapse
|
10
|
Ernest-Suarez K, Panaccione R. Update on the role of upadacitinib in the treatment of adults with moderately to severely active ulcerative colitis. Therap Adv Gastroenterol 2023; 16:17562848231158235. [PMID: 36923487 PMCID: PMC10009038 DOI: 10.1177/17562848231158235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 03/16/2023] Open
Abstract
With further knowledge of the pathogenesis of inflammatory bowel disease, small oral molecules have become available, including the Janus kinase (JAK) inhibitors. Upadacitinib (UPA) is a selective JAK1 inhibitor and has become the newest drug in this class, with recent approval for the management of moderate-to-severe ulcerative colitis. The large phase III program (including the U-ACHIEVE and U-ACCOMPLISH parallel induction trials and the U-ACHIEVE Maintenance trial) demonstrated superiority over placebo, for all primary and secondary endpoints including key clinical, endoscopic, and histological outcomes utilizing 45 mg orally (po) once daily (OD) during induction and either 30 mg or 15 mg po OD in maintenance. From a safety perspective, UPA has proven to be a safe and well-tolerated medication across immune-mediated diseases with manageable adverse risks such as an increase in herpes zoster. Proper discussion and patient profiling are essential when positioning UPA, considering efficacy and potential risks associated with this highly effective medication.
Collapse
Affiliation(s)
- Kenneth Ernest-Suarez
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Rm 6D32, Cal Wenzel Precision Health Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| |
Collapse
|